FIRST AID AFRICA Syllabus 2 nd Edition First Aid Africa 2011
Editors Scott Clarke - Policy and Development Coordinator Laura Janes Dan Costigliola - Training Coordinator With thanks to Lyn Covey - First Aid Technical Support Officer, British Red Cross Harry McLaren - Alumni and Communications Coordinator Matt May Copyright 2011 This document is the exclusive property of First Aid Africa. It may not be quoted, distributed or copied, in whole or in part, without the explicit permission of the copyright holder; First Aid Africa. Disclaimer Every effort has been made to ensure that the information contained in this document is correct at the time of going to press. However, this document is designed for use overseas not the United Kingdom. First Aid Africa take no responsibility for the use of any of the information or techniques in this document. If you have any enquiries about this syllabus, please contact scottclarke@firstaidafrica.com. First Aid Africa 2011 2
CONTENTS 1. Introduction 4 2. How to use this syllabus 4 3. Teaching Tips 5 4. First Aid Africa Courses 6 5. First Aid Aware 5.1 Introduction to First Aid 7 5.2 The Unconscious Casualty 8 5.3 Blood Loss and Shock 9 5.4 Burns 13 5.5 Fractures 16 6. Initial First Aid 18 7. Advanced First Aid 7.1 Introduction to First Aid 19 7.2 First Aid Equipment 21 7.3 The Unconscious Casualty 22 7.4 Blood Loss and Shock 24 7.5 Burns 31 7.6 Fractures 35 7.7 Head Injury 42 7.8 Medical Conditions 44 7.9 Choking 58 7.10 Sports Injuries 61 7.11 Moving, Handling & Transporting Casualties 63 8. Changes Log 67 First Aid Africa 2011 3
SYLLABUS INTRODUCTION The aim of this guide is to help you to adapt what you have learnt in your UK first aid course to teaching in overseas. It is not designed to replace your first aid manual but should be used alongside your manual when planning lessons. If you have any questions or problems whilst using this guide, please contact scottclarke@firstaidafrica.com. HOW TO USE THIS SYLLABUS The next few pages provide information about the different levels of course that you can deliver. The rest of the trainer s guide contains the syllabuses for each of the courses: At the start of each section is a reference for the appropriate pages in the first aid manual and, where necessary, the important changes between the older and most up to date versions of the manual. You should make sure you read these sections before you plan your lesson so that you understand enough of the theory behind the subject to be able to teach it. The learning objectives are given for each section. They are not designed to be given to your class but rather to guide your teaching. Any adaptations or additions in technique for overseas are included. It is very important that you read this section to make sure your course is relevant. Key, often lifesaving, points to be emphasised with your class are highlighted. Any resources we have available to help you teach the topic are referenced at the end of each section. First Aid Africa 2011 4
TEACHING TIPS Planning Read over the relevant sections of your manual and this guide before you try to plan your lesson It can take time to relax into teaching your classes - preparing well makes this a lot easier When planning your lessons it is important to think about: Who are you trying to teach? age, language abilities, disabilities, number in the class, previous knowledge etc What are you trying to teach? what do you want your class be able to do by the end of your session? What do you need to help you? equipment, visual aids, number of trainers etc How are you going to teach it? demonstration, class practice, scenarios etc First aid is a practical subject - give your class as much chance to practise the practical skills as possible and don t focus as much on theory Teaching Be enthusiastic Try and vary how you teach - don t just stand at the front lecturing the whole time First aid is a practical subject - the more time your students spend practising the techniques the better Have fun...but remember you re the teacher, when teaching children especially, you need to earn their respect and maintain it Don t talk over the class, make sure they re quiet before you start Don t contradict each other in front of the class When telling a child off, don t threaten to do something you re not going to do...they learn quick! Assessments Assessment information is given in a separate document. It s a good idea to read up on how the course will be assessed before you plan your lessons, particularly in First Aid Aware. Assessments are competence based and you can continually assess your students rather than having to do specific assessments at the end of the course. Remember, if you think things aren t going as well as they could, talk to your team leaders early on. We re here to help you and your students get the best out of the project! First Aid Africa 2011 5
FIRST AID AFRICA COURSES First Aid Africa courses are based on courses that are currently offered by voluntary aid organisations in the UK but are adapted for overseas. The courses do not cover CPR as it is unlikely that the rest of the steps of the Chain-of-Survival will be in place. The information below gives the suggested target audience for each course you can deliver as well as the teaching time needed for delivery. It is intended as a guide to help you decide which course is appropriate for your class rather than as a set rule of what you must teach and how long it should take. FIRST AID AWARE Pages: 7-17 Time: 3 hours / ½ day Audience: Primary school students, people who just want to learn basic skills First Aid Aware is designed to cover basic first aid and emphasises the need to get help from someone who knows more. It covers the life-saving, initial aspects of treatment for: an unconscious casualty, blood loss and shock; and the initial treatments for: burns and, fractures. It is similar to a UK Save-a-Life Course. It is not designed to cover a large amount of theory. In order to pass this course, students do not need to be able to understand the principles behind treatment but they must be able to treat effectively. INTIAL FIRST AID Pages: 18 Time: Approx 2 days / 14 hours - 3 days including assessments Audience: Teachers, secondary school students and community members who want to learn skills without learning a large amount of theory Initial First Aid is designed to teach the skills needed to initially treat a casualty and arrange for an Advanced First Aider to come and help. It covers a similar amount of content to a UK Basic First Aid Course. It is not designed to cover a large amount of theory. In order to pass this course, students do not need to be able to understand the principles behind treatment but they must be able to treat effectively. ADVANCED FIRST AID Pages: 19-66 Time: Approx 5 days / 28 hours - including assessments Audience: Teachers, older students and community members who have a desire to learn First Aid - this course requires a reasonable level of English Advanced First Aid is currently the most advanced course First Aid Africa run overseas. It covers a similar amount of content to a UK Standard First Aid Course. The course covers everything from the initial treatment of a casualty through to the transport of the casualty to the hospital as well as covering some of the theory behind the treatments. Both local first aid equipment and improvised techniques are used throughout. You should encourage teachers in your school to take this course. First Aid Africa 2011 6
FIRST AID AWARE 5.1 INTRODUCTION TO FIRST AID First Aid Manual 9th Edition - Chapters 1 & 2, p12-37 8th Edition - Chapter 1, p12-28 Learning Objectives Protection from infection understand the risk of cross infection involved with first aid understand the importance of using gloves to protect both the casualty and the first aider Assessing danger understand that the most important person at the scene is the first aider understand the importance of checking for danger be able to give examples of danger and how to deal with them including: road traffic accidents fire electricity muggings Overseas Make sure you make it clear that GLOVES reduce the risk of infection Dangers you use as examples should be appropriate to the area - snakes and machetes rather than kettles and freezing lakes Do not be afraid to give HIV as an example of infection that can be transmitted - many older African children will know more about HIV than you Road traffic accidents are very common in Africa Key Points The first aider is the most important person - you can not help someone else if you are injured - check for DANGER Wear GLOVES - you should recap this at the start of every treatment you do! Resources Page 4 - Danger First Aid Africa 2011 7
FIRST AID AWARE 5.2 THE UNCONSCIOUS CASUALTY First Aid Manual 9th Edition - Chapters 4, p54-79; Chapter 3, p44-53, Chapter 13, p256-257 8th Edition - Chapter 3, p71-98; Chapter 13, p252-262 Learning Objectives DRS ABC be able to carry out the steps in DRS AB: Check for Danger using the knowledge from the previous section Check for Response shake and shout Shout for Help Open the Airway using the head-tilt, chin-lift method Check for normal Breathing using the look, listen and feel method Circulation - check for life threatening blood loss and treat Recovery Position understand the importance of the recovery position especially: having the casualty on their side - in case they re sick maintaining an open airway - without an airway they will die having a casualty in a stable position - to keep them safe be able to carry out the steps of the recovery position Getting Help understand the importance of getting help to transport an unconscious casualty Key Points Check for danger before helping any casualty If you do not open an unconscious person s airway and keep it open, they will die because they won t be able to breath Always re-open a casualty s airway after you have moved them, even if you have only moved them slightly The recovery position is the safest position for an unconscious casualty to be in Get help as quickly as possible Resources Page 7 - DRS ABC Page 8 - Recovery Position First Aid Africa 2011 8
FIRST AID AWARE 5.3 BLOOD LOSS AND SHOCK First Aid Manual 9th Edition - Chapter 1, p16-19; Chapter 6, p106-109, 113-129; Chapter 13, p266-267; Chapter 5, p103 8th Edition - Chapter 5, p118-122, Chapter 6, p127-144; Chapter 13, p270; Chapter 4, p112-113 Learning Objectives Personal Protection understand the importance of wearing gloves to treat a wound Types of Wounds be able to distinguish between severe bleeding and minor wounds understand that major wounds lead to major blood loss which needs to be stemmed quickly Severe Bleeding - Pressure understand that you should be apply PRESSURE to a wound to stop the bleeding understand different methods of applying pressure, mainly, by using the patient or first aider s gloved hands by using a bandage by using an improvised bandage Severe Bleeding Bandaging To Apply Pressure be able to use a sterile ambulance dressing / local equivalent to bandage a severe wound to the arms including the hands the legs the head be able to select and use an appropriate improvised bandage which should be as clean as possible able to produce sufficient pressure large enough to cover the wound understand the importance of, and be able to check for, circulation beyond the bandage/improvised bandage understand what to do when blood soaks through a bandage Severe Bleeding Embedded Object understand that you should not remove an embedded object understand why you should apply pressure either side of the object, not directly on top First Aid Africa 2011 9
FIRST AID AWARE 5.3 BLOOD LOSS AND SHOCK be able to apply pressure either side of the embedded object using their hands be able to bandage around an embedded object Shock understand that shock can happen as a result of blood loss be able to recognise and understand the main signs and symptoms of shock, mainly a rapid pulse pale, cold, clammy skin weakness and dizziness / tiredness and decreasing level of consciousness eventually leading to unconsciousness thirst nausea feeling cold Shock - Treatment be able to treat a casualty for shock by lying the patient down keeping them warm monitoring their level of consciousness and being ready to treat them for unconsciousness Severe Bleeding and Shock - Getting Help understand the importance of getting help to treat a casualty with a severe bleed and/or shock know where to get help Minor Wounds - Treatment By the end of this section, a learner should understand that: minor wounds should be seen by a more qualified first aider Snake Bites be able to recognise a snake bite understand that a bite from a venomous snake is very dangerous be able to treat a snake bite by: not approaching if the snake is still near the casualty keeping the casualty as calm and still as possible Overseas Emphasise using gloves Teach using both local and UK bandages First Aid Africa 2011 10
FIRST AID AWARE 5.3 BLOOD LOSS AND SHOCK It is custom in Africa to wash the wound...if it is a minor graze or small cut, perfect! However, if it is a large cut or wound there is no need for it to be placed under the water as the blood would carry out any residues from inside the wound. The priority is to stop the bleed - PRESSURE Elevation is not taught in FAA overseas courses - an international review found that there is no evidence that pressure in conjunction with elevation is more effective than pressure alone and this is easier to teach Raising the patient s legs as part of the treatment for shock is not taught in FAA overseas courses no studies have shown that there is any survival benefit over lying the casualty down alone and at least one study has shown that it worsens outcome. In addition, it is easier to teach that the treatment for shock is to lie the patient down and keep them warm Improvised bandages should be as clean as possible, non-fluffy, able to produce sufficient pressure and cover the entire wound. An example would be a clean t-shirt. The bandage should be replaced with a sterile dressing as soon as possible. Get help from a more advanced first aider as soon as possible Venomous snakes are more common in Africa. A bite from a venomous snake generally looks like the diagram below but any snake bite should be treated as if the snake is venomous Large fangs which Other teeth inject venom Do not approach a casualty with a snake bite when the snake is still near the casualty Do not try and catch the snake Calm a casualty with a snake bite down as quickly as possible, make them lie down with their head and shoulders raised - get help Do not cut open the wound or try and suck out the venom - this puts the first aider in Key Points Check for danger before helping any casualty Wear GLOVES The priority when treating severe wounds is to stop the bleeding Treatment for a severe bleed is PRESSURE Bleeding, both internal and external can lead to shock Shock is very dangerous and can cause death Someone who is shocked will be pale, cold, clammy, feeling weak/tired/dizzy/ nauseous, will have a decreasing level of consciousness and will have a rapid but weak pulse Treatment for shock is laying the casualty down, keeping them warm and stopping the bleeding with pressure - transport to HOSPITAL If someone has been bitten by a snake, make sure the area is safe before treating - do not approach a casualty when the snake is still near them The key parts of treating for a snake bite are: get the casualty to lay still with their head and shoulders raised, get help - don t let them walk Do not cut open the wound or try and suck out the venom - this puts the first aider in First Aid Africa 2011 11
FIRST AID AWARE 5.3 BLOOD LOSS AND SHOCK Resources Page 11 - Severe Bleeding Page 14 - Snake Bites First Aid Africa 2011 12
FIRST AID AWARE 5.4 BURNS First Aid Manual 9th Edition - Chapter 9, p176-189; Chapter 13, p274-275 8th Edition - Chapter 9, p189-200; Chapter 13, p277 Learning Objectives Burns understand that a burn is damage to the skin understand that blisters are part of the body's defence against burns and that you should not burst them understand that chemicals may still be burning, even if you can t see them understand that burns to the airway are very dangerous as they can stop you being able to breath Cooling understand that unless a burn is cooled and/or the chemical is fully washed off, damage will continue to be done to the skin understand that a normal burn has to be cooled until it no longer feels like it is burning and for a minimum of 10 minutes understand why clean, cold, running water is the best thing to cool a burn be able to cool a burn using running, cold, clean liquids (not strong alcohol) a basin of cold, clean liquid and a cup running, unclean, cold liquid and something to cover the burn a basin of cold, unclean liquid, a cup and something to cover the burn Additional Treatment understand that anything tight around a limb near a burn such as clothing or rings should be removed because of the risk of swelling understand why you should not remove anything that is stuck to the burn Getting Help Overseas The English word burn is not very commonly used in Africa. If you try explaining to someone in English what a burn is it can be quite hard so it s a good idea to have pictures of burns, or examples of things that can give you a burn, to help you First Aid Africa 2011 13
FIRST AID AWARE 5.4 BURNS The information below is not intended to be given to every class during the First Aid Aware course. It is intended to help you answer questions Burns are generally very badly treated by lay people in Africa because of the wide variety of local remedies used, such as putting rabbit hair on the burn to help it heal. Invariably, these increase the chance of infection and make the situation worse In many cases, local remedies are part of the traditions of local culture - do not rubbish the ideas but explain why they might not work as well as the treatment you are teaching them, in terms of lack of cooling and increased chance of infection - many local people will have stories of burns that have got worse after local treatment and these can help convince people Burns ALWAYS need to be cooled first - if the burn is not cooled, it will continue to cause damage deeper and deeper in to the skin even if you cannot see it doing so. Some local remedies are actually quite good BUT only if applied AFTER cooling - for example honey is a natural antiseptic and seals the skin preventing infection from entering. However, if you put honey on a burn which isn t cool, it s like adding a glaze to a cooking steak! The best thing to cool a burn is clean, cold, running water clean to reduce the chance of infection cold because you want to cool the burn running because running water takes heat with it as it goes and stays cool where as standing water heats up if you put a burn into it You are almost guaranteed to be asked these questions: What if I don t have water? What if I don t have clean water? What if I don t have much water? What if I don t have running water? combinations of the above! The priority initially is always to cool the burn If you do not have water, any cool clean liquid will do (except drinks with a high alcohol content such as Konyagi as it really hurts - beer is ok) If you only have unclean liquid, cover the burn very loosely with something clean and non-adherent/fluffy - preferably plastic - and pour water over the top. The cooling process will take longer If you don't have very much liquid or liquid is not running, place a big bowl underneath the area you are cooling to collect the liquid and then use a cup or a Key Points Check for danger before helping any casualty - especially things that may have caused the burn Wear GLOVES Initial treatment of a burn is cooling to stop more damage A burn should ALWAYS be cooled first - cold, clean, running water is the best thing to cool a burn - if you don t have it, do the best you can! Most burns should be cooled until they no longer feel hot to the casualty - at least 10 minutes for most Get help from a more advanced first aider, doctor or nurse Bad burns can lead to shock First Aid Africa 2011 14
FIRST AID AWARE 5.4 BURNS Resources Page 16 - Burns (examples) Page 17 - Burns (treatment) First Aid Africa 2011 15
FIRST AID AWARE 5.5 FRACTURES First Aid Manual 9th Edition - Chapter 7, p130-158; Chapter 13, p268, p272 8th Edition - Chapter 7, p145-174, Chapter 13, p273, p276 The changes between the manuals are not relevant for this course. Learning Objectives Fractures understand what a fracture is understand that a fracture can be open or closed be able to recognise a fracture understand that if you are not completely sure that something is NOT fractured, you should get help but treat it as a fracture until help arrives Support and Protect understand that the casualty will automatically adopt a position to support and protect the fracture understand that the aim of treating a fracture is to support and protect the fracture site Open Fracture understand the that you need to control the bleeding before treating the fracture be able to control the bleeding of an open fracture by treating the protruding bone as an embedded object understand that after you have controlled the bleeding, you should treat the fracture as normal Upper Limb be able to provide the initial treatment for a suspected fracture to an upper limb by: asking the casualty to support and protect the area themselves getting help from a more advanced first aider Lower Limb be able to provide the initial treatment for a suspected fracture to a lower limb by: providing initial support above and below the fracture site using the first aiders hands First Aid Africa 2011 16
FIRST AID AWARE 5.5 FRACTURES Key Points Check for danger before helping any casualty - especially things that may have caused the fracture Wear GLOVES Types of fracture: Closed skin is not broken Open bone ends may still have damaged nearby blood vessels and so risk of internal bleeding bone poking through skin likely to be bleeding treating the bleed takes priority - treat as an embedded object Both can be serious and lead to shock Always fully expose a fracture site to make sure there is no bleeding The principle behind treating all suspected fractures is to support and protect Upper Body Fractures Allow the casualty to support the suspected fracture for themselves Get help from a more advanced first aider Upper and Lower Leg Fractures Support above and below the suspected fracture site with your hands Get help from a more advanced first aider - don t let go send someone else - if you are on your own, get help first Resources Page 23 - Leg Fracture First Aid Africa 2011 17
INITIAL FIRST AID The Initial First Aid course is based on the Advanced First Aid Course. The differences are explained below. For all of the sections, concentrate more on practical skills than theory. Transport is not included - get help from a more advanced first aider or do the best they can. UNIT TITLE ADVANCED FIRST AID UNIT NOTES RESOURCES INTRODUCTION 6.1 7.1 Page 4 TO FIRST AID Just make them aware of both FIRST AID UK and local bandages - not how 6.2 7.2 Page 6 EQUIPMENT to make Teach triangular bandage folding 6.3 THE UNCONSCIOUS CASUALTY 7.3 Do not teach baby recovery position Pages 7 & 8 BLOOD LOSS Do not teach abdomen or open 6.4 7.4 Pages 11 & 14 AND SHOCK chest wounds 6.5 BURNS 7.5 When teaching which burns go to hospital, emphasise that basically the bad, big and burns to delicate areas go to hospital, don t focus too much on all the different criteria - if in doubt send to hospital Pages 16 & 18 6.6 FRACTURES 7.6 Only teach holding above and below a fracture to the lower limb, not bandaging - get help from a more advanced first aider Pages 21, 22, 23 6.7 HEAD INJURY 7.7 --- 6.8 Teach the initial treatment of seizures, diabetes, and asthma MEDICAL and how to recognise heart 7.8 CONDITIONS attack & stroke. For all other conditions - get help from a more advanced first aider --- 6.9 CHOKING 7.9 Pages 33 & 34 SPORTS Only mention bandaging briefly - 6.10 7.10 --- INJURIES no practise just demo MOVING, HANDLING & TRANSPORTING CASUALTIES 7.11 Do not teach - get help from a more advanced first aider / do their best --- First Aid Africa 2011 18
7.1 INTRODUCTION TO FIRST AID First Aid Manual 9th Edition - Chapters 1 & 2, p12-37 8th Edition - Chapter 1, p12-28 Learning Objectives Role of the first aider By the end of this section, a learner should understand the aims of first aid including: Preserve life Prevent condition from worsening Promote recovery Protection from infection understand the risk of cross infection involved with first aid understand the importance of using gloves to protect both the casualty and the first aider understand the importance of safe disposal of contaminated equipment Assessing danger understand that the most important person at the scene is the first aider understand the importance of checking for danger be able to give examples of danger and how to deal with them including: road traffic accidents fire electricity muggings First Aid Priorities understand that priority is given to the injury most likely to kill the person first understand that in most cases, airway takes priority First Aid Equipment understand what equipment should be included in their first aid kit Overseas Make sure you make it clear that GLOVES reduce the risk of infection Get details of local hospitals/dispensaries as contaminated materials can be safely disposed of in many African Hospitals - team leaders and teachers will be able to help you do this Dangers you use as examples should be appropriate to the area - snakes and machetes rather than kettles and freezing lakes First Aid Africa 2011 19
7.1 INTRODUCTION TO FIRST AID Do not be afraid to give HIV as an example of infection that can be transmitted - many older African children will know more about HIV than you Road traffic accidents are very common in Africa Making local bandages will be covered in your induction and information is also Key Points The first aider is the most important person - you can not help someone else if you are injured - check for DANGER Wear GLOVES - you should recap this at the start of every treatment you do! The most important thing is to save the person s life - treat the injury that is most likely to kill them first - in most cases airway is the most important Resources Page 4 - Danger First Aid Africa 2011 20
7.2 FIRST AID EQUIPMENT First Aid Manual 9th Edition - Chapter 12, p249, 253 8th Edition - Chapter 2, p57, 62 Learning Objectives Equipment Availability By the end of this section, a learner should understand that: Important first aid equipment can be expensive and difficult to get hold of Alternatives can be made using readily available, cheaper, local materials If there is no proper equipment available, you should improvise and do the best that you can Local Equipment By the end of this section, a learner should be able to make equipment out of local materials: Triangular bandages - material cut to size Ambulance dressings - material strip and sanitary pad Triangular Bandages By the end of this section, a learner should be able to fold triangular bandages into: Broad-fold Narrow-fold Overseas First aid equipment imported from the Western World may be difficult to get hold of in overseas and is usually expensive Effective alternatives can be made from readily available local materials which are cheaper Triangular bandages can be made, simply by cutting a piece of material down to size - try and use a similar material to that which the UK triangular bandages are made out of Bandages which are similar to ambulance dressings can be made by sticking a sanitary pad to a strip of cloth Whilst sanitary pads may appear to be an odd choice, they are in fact made for purpose - they are designed for absorbing blood and are very clean. They are also readily available in African pharmacies relatively cheaply Making equipment out of local materials will be covered in your induction as well as in Resources Page 5 - Local Bandages Page 6 - Triangular Bandages First Aid Africa 2011 21
7.3 THE UNCONSCIOUS CASUALTY First Aid Manual 9th Edition - Chapters 4, p54-79; Chapter 3, p44-53, Chapter 13, p256-257 8th Edition - Chapter 3, p71-98; Chapter 13, p252-262 Learning Objectives Unconsciousness understand what the term unconscious means be able to give example causes of unconsciousness DRS ABC understand the importance of DRS ABC be able to carry out the steps in DRS ABC: Check for Danger using the knowledge from the previous section Check for Response using Alert, Voice, Pain, Unresponsive Shout for Help Open the Airway using the head-tilt, chin-lift method Check for normal Breathing using the look, listen and feel method Circulation - check for life threatening blood loss and treat Recovery Position understand the importance of the recovery position especially: having the casualty on their side maintaining an open airway having a casualty in a stable position be able to carry out the steps of the recovery position Head-to-toe Survey understand the importance of sending someone to organise transport before starting a head-to-toe survey - the person needs to get to hospital quickly understand the reasons behind doing a head-to-toe survey be able to carry out a head-to-toe survey Babies understand the differences in treatment for an unconscious baby be able to put a baby in the modified recovery position Safe Transport understand the importance of transporting an unconscious casualty to hospital quickly Transport of an unconscious casualty will be covered in section 7.10: Moving, Handling & Transporting Casualties First Aid Africa 2011 22
7.3 THE UNCONSCIOUS CASUALTY Overseas In the UK, we ring 999 and wait for an ambulance to arrive for an unconscious casualty - in Africa the first aider must arrange for transport to the nearest hospital as quickly as possible - see section 7.10: Moving, Handling & Transporting Casualties If their conscious level improves they still need to go to the hospital Key Points Check for danger before helping any casualty If you do not open an unconscious person s airway and keep it open, they will die because they won t be able to breath Always re-open a casualty s airway after you have moved them, even if you have only moved them slightly The recovery position is the safest position for an unconscious casualty to be in An unconscious casualty should be transported to hospital as quickly as possible Resources Page 7 - DRS ABC Page 9 - Recovery Position Page 10 - Unconscious Baby First Aid Africa 2011 23
7.4 BLOOD LOSS AND SHOCK First Aid Manual 9th Edition - Chapter 1, p16-19; Chapter 6, p106-109, 113-129; Chapter 13, p266-267; Chapter 5, p103 8th Edition - Chapter 5, p118-122, Chapter 6, p127-144; Chapter 13, p270; Chapter 4, p112-113 The treatment for a snake bite has changed in the 9th Edition: 1. Reassure and calm the casualty and lie them down with their head and shoulders raised - call 999/112 for emergency help 2. If there is no pain or the wound is deep, apply an ambulance dressing at the site of the bite. Do not remove clothing from around the site (can speed up venom absorption) 3. Apply another pressure bandage (crepe) from the bite, extending as far as possible up the limb (as per 8th Edition) - if possible mark the site of the bite 4. If the bite is on a limb, immobilise the affected limb, in a sling if it is an arm, or if it is a leg that is affected, secure it to the other leg with broad- and narrow- fold bandages 5. Monitor and record vital signs while waiting for help to arrive. The casualty needs to remain still Take precautions to prevent others being bitten. DO NOT try to capture the snake - get help from someone who is qualified. The 9th Edition emphasises the need to hold the bandage firmly against the wound when treating an abdominal wound. This reflects the difficulties in tying a bandage around the abdomen when the casualty is laying down and suggests simply holding a sterile dressing on with your gloved hands, in addition to securing the dressing Learning Objectives The Importance of Blood understand the importance of blood, including its role in carrying oxygen and nutrients around the body its role in removing waste materials from the body its role in the transmission of disease Personal Protection understand the importance of wearing gloves to treat a wound Types of Wounds be able to distinguish between severe bleeding and minor wounds understand the implications of the type of wound on the priorities of treatment, mainly that: First Aid Africa 2011 24
7.4 BLOOD LOSS AND SHOCK major wounds lead to major blood loss which needs to be stemmed quickly minor wounds are likely to become infected Severe Bleeding - Pressure understand the importance of pressure when treating a severe bleed, mainly, that it improves clotting stems the flow of blood understand different methods of applying pressure, mainly, by using the patient or first aider s gloved hands by using a bandage by using an improvised bandage Severe Bleeding Bandaging To Apply Pressure be able to use a sterile ambulance dressing / Tanzanian equivalent to bandage a severe wound to the arms including the hands the legs the head be able to select and use an appropriate improvised bandage which should be as clean as possible able to produce sufficient pressure large enough to cover the wound understand the importance of, and be able to check for, circulation beyond the bandage/improvised bandage understand what to do when blood soaks through a bandage Severe Bleeding Embedded Object understand why you should not remove an embedded object understand why you should apply pressure either side of the object, not directly on top be able to apply pressure either side of the embedded object using their hands be able to bandage around an embedded object Severe Bleeding - Tourniquet understand that you should ONLY use a tourniquet for wounds to the limbs which were NOT controlled by pressure alone understand the potential complications of using a tourniquet and subsequent lack of blood flow past the point of application, mainly temporary or permanent nerve damage temporary or permanent muscle damage temporary or permanent damage to blood vessels loss of the limb understand that the longer it takes to get the patient to hospital, the more likely they are to suffer from one of the complications above 2 hours - generally no permanent effects First Aid Africa 2011 25
7.4 BLOOD LOSS AND SHOCK >6 hours requires amputation understand that you should tell the casualty that there is a chance they may lose their limb if they do not get to a hospital quickly understand the importance of recording the time that the tourniquet was applied and passing on the information to the hospital - ideally, by writing the time on the limb, above the tourniquet be able to make and apply an improvised tourniquet Shock understand what shock is, mainly that it is the body's defence against blood loss, either external or internal the blood supply to the peripheral tissues, such as the skin, shuts down to divert blood to the important internal organs such as the brain and the liver blood pools in the muscles be able to recognise and understand the main signs and symptoms of shock, mainly a rapid pulse pale, cold, clammy skin weakness and dizziness / tiredness and decreasing level of consciousness eventually leading to unconsciousness thirst nausea feeling cold Shock - Treatment be able to treat a casualty for shock by lying the patient down keeping them warm monitoring their level of consciousness and being ready to treat them for unconsciousness Severe Bleeding and Shock - Safe Transport understand the importance of transporting a casualty with a severe bleed or in shock to hospital quickly Transport of a casualty with a severe bleed or showing signs of shock will be covered in section 7.10: Moving, Handling & Transporting Casualties Minor Wounds - Treatment understand the importance of washing a minor wound with clean water, mainly that it cleans the wound reducing the risk of infection understand the importance of washing around the wound understand the need to cover a minor wound to prevent infection be able to cover a minor wound using a sterile gauze or sterile non-adhesive pad be able to cover a minor wound using an improvised dressing which should be First Aid Africa 2011 26
7.4 BLOOD LOSS AND SHOCK as clean as possible large enough to completely cover the wound Infection By the end of this section, a learner should understand that: any wound can get infected infection is caused by bacteria contaminating the wound if an infected wound is not treated it can lead to serious illness Infection - Recognition and Treatment be able to recognise an infected wound understand the importance of carefully cleaning an infected wound understand that a badly affected wound needs to be treated by a doctor or nurse Animal and Human Bites understand the increased risk of infection from animal and human bites be able to treat a deep wound caused by a bite like a normal deep wound be able to treat a less severe bite by washing with soap and water and covering with a sterile dressing understand the importance of transporting a casualty with a bite to hospital Snake Bites be able to recognise a snake bite understand the risks of a bite from a venomous snake understand that the treatment of a venomous snake bite relies on trying to prevent the venom from spreading quickly be able to treat a snake bite by: keeping the casualty as calm and still as possible carefully lying the casualty down with their head and shoulders raised applying compression bandages immobilising an affected limb arranging immediate transport to hospital with as little movement of the casualty as possible Open Chest Wound understand that an open wound to the chest can cause difficult breathing and why be able to treat an open chest wound by: sitting the casualty up and leaning them towards the injured side First Aid Africa 2011 27
7.4 BLOOD LOSS AND SHOCK applying a sterile dressing to the wound with a layer of plastic over the top, taped on three sides (leaving the lower side unattached ) arranging immediate transport to hospital Abdominal Wound be able to treat an abdominal wound by: lying the casualty down loosening any tight clothing such as a belt or shirt covering the wound with a sterile dressing and holding it firmly gently raising and supporting the casualty s knees to ease the strain on the injury transporting to hospital as quickly as possible understand that they should not touch any protruding intestine be able to cover any protruding intestine with a clean plastic bag or cling film Eye Wound understand that all eye injuries are potentially serious because of the risk to the casualty s vision understand that you should not try and remove anything sticking to or embedded in the eyeball Overseas Emphasise using gloves Making local bandages will be covered in your induction and information is also included in section 7.2: First Aid Equipment It is custom in Africa to wash the wound...if it is a minor graze or small cut, perfect! However, if it is a large cut or wound there is no need for it to be placed under the water as the blood would carry out any residues from inside the wound. The priority is to stop the bleed - PRESSURE Elevation is not taught in FAA overseas courses - an international review found that there is no evidence that pressure in conjunction with elevation is more effective than pressure alone and this is easier to teach Use of a tourniquet should be taught as treatment for a catastrophic bleed of a limb that pressure has failed to control evidence from military and remote area studies suggest that these are generally safe, that most side effects are reversible and that severe side effects are rare. Whereas in the UK an ambulance crew will be on scene within minutes, in our project countries, first aiders must deal with everything and it is important to offer them an alternative treatment for such life threatening injuries Use of an improvised tourniquet will be covered in your induction and in the resources for this section When applying a tourniquet, make sure that you note the time of application and pass it on to the hospital When applying a tourniquet, warn the casualty that there limb may be damaged and that they may lose their limb - in areas where a hospital is nearby this risk is relatively low but much higher when transport times increase - after 6 hours almost all of the limb will have died First Aid Africa 2011 28
7.4 BLOOD LOSS AND SHOCK Raising the patient s legs as part of the treatment for shock is not taught in FAA overseas courses no studies have shown that there is any survival benefit over lying the casualty down alone and at least one study has shown that it worsens outcome. In addition, it is easier to teach that the treatment for shock is to lie the patient down and keep them warm Improvised bandages should be as clean as possible, non-fluffy, able to produce sufficient pressure and cover the entire wound. An example would be a clean t-shirt. The bandage should be replaced with a sterile dressing as soon as possible. In the UK, we ring 999 and wait for an ambulance to arrive for a casualty with a severe bleed/showing signs of shock/open chest wound etc - in Africa the first aider must arrange for transport to the nearest hospital as quickly as possible - see section 7.10: Moving, Handling & Transporting Casualties All animal and human bites should be seen by a doctor because of the increased risk of infection in Africa. Casualties should see a doctor as soon as possible and should be transported to hospital immediately if rabies (see first aid manual) is suspected Venomous snakes are more common in Africa. A bite from a venomous snake generally looks like the diagram below but any snake bite should be treated as if the snake is venomous Large fangs which Other teeth inject venom Casualties with snake bites should be transported to hospital as quickly as possible with as little movement as possible to slow movement of venom around the body should be transported laying down with their head and shoulders raised should be carried and should not be allowed to walk Do not cut open the wound from a snake bite or try and suck out the venom - this puts the first aider in danger Key Points Check for danger before helping any casualty Wear GLOVES The priority when treating severe wounds is to stop the bleeding Treatment for a severe bleed is PRESSURE A tourniquet can be used ONLY when pressure has failed to control a major bleed from a limb When applying a tourniquet you MUST record the time of application and pass it on to the hospital When applying a tourniquet you must tell the casualty that they may suffer damage to, and may lose, their limb - the risk of damage increases the longer it takes to get to hospital - remember, in the case of a catastrophic bleed, it s still saving their life Bleeding, both internal and external can lead to shock Shock is very dangerous and can cause death Someone who is in shock will be pale, cold, clammy, feeling weak/tired/dizzy/ nauseous, will have a decreasing level of consciousness and will have a rapid but weak pulse First Aid Africa 2011 29
7.4 BLOOD LOSS AND SHOCK Treatment for shock is laying the casualty down, keeping them warm and stopping the bleeding with pressure - transport to HOSPITAL The priority when treating minor wounds is to prevent infection Treatment for a minor wound is washing the wound and covering it, ideally with something sterile Infected wounds can lead to severe illness Any wound that gets badly infected or if the casualty is generally unwell needs to seen by a doctor/nurse Other infected wounds need to be cleaned and covered Animal and human bites carry an increased risk of infection because of the bacteria in the mouth Severe bites should be treated as for a severe wound because the priority is stopping the bleeding Minor bites should be cleaned with soap and water and covered with a sterile dressing All bites should be seen by a doctor/nurse because of the increased risk of infection If someone has been bitten by a snake, make sure the area is safe before treating Treatment for a snake bite aims to slow the spread of poison spreading around the body The key parts of treating for a snake bite are: get the casualty to lay still with their head and shoulders raised, apply a compression bandage to the affected limb and transport to hospital with as little movement as possible (the casualty shouldn t walk) Do not cut open the wound from a snake bite or try and suck out the venom - this puts the first aider in danger A casualty with an open chest wound should be sat up and leaned towards the injured side, a sterile pad and plastic should be applied to the wound and taped on 3 sides. Transport arranged to hospital - initially they should be transported sitting up and leaning to the injured side and as normal if they become unconscious but rolled onto the injured side A casualty with an abdominal wound should be laid down, a sterile dressing firmly applied to wound and held firmly in place, the knees raised and supported and then transported to hospital. Any protruding bits of intestine should not be touched but should be covered with a clean, wet dressing. Transport immediately to hospital A casualty with an eye wound should be told to keep both eyes still. A sterile pad Resources Page 12 - Severe Bleeding Page 13 - Tourniquet First Aid Africa 2011 30
7.5 BURNS First Aid Manual 9th Edition - Chapter 9, p176-189; Chapter 13, p274-275 8th Edition - Chapter 9, p189-200; Chapter 13, p277 Learning Objectives Burns understand that a burn is damage to the skin understand the different things that can cause a burn such as: hot objects hot liquids radiation chemicals cold objects electricity (2 burns - the entry and exit point) understand that burns can be different depths: superficial partial full thickness be able to recognise a burn and identify its depth understand why burns progressively get worse unless treated understand why a burn is serious, mainly that they can lead to infection because the skin is compromised that they can lead to shock because fluid collects around the burn that they swell and can compromise the blood supply to different areas of the body understand that blisters are part of the body's defence against burns and that you should not burst them understand that electrical burns can cause problems with your heart or brain understand that chemicals may still be burning, even if you can t see them understand that burns to the airway are very dangerous as they can stop you being able to breath Treatment Misunderstandings know some of the misunderstandings local people have about treatment and the reasons behind them Cooling understand that unless a burn is cooled and/or the chemical is fully washed off, damage will continue to be done to the skin understand that a normal burn has to be cooled until it no longer feels like it is burning and for a minimum of 10 minutes understand that a chemical burn has to be cooled until it no longer feels like it is burning and for a minimum of 20 minutes First Aid Africa 2011 31
7.5 BURNS understand why clean, cold, running water is the best thing to cool a burn be able to cool a burn using running, cold, clean liquids (not strong alcohol) a basin of cold, clean liquid and a cup running, unclean, cold liquid and something to cover the burn a basin of cold, unclean liquid, a cup and something to cover the burn Covering understand that covering a cooled burn reduces the risk of infection understand that a cooled burn should be covered loosely, from end to end, with a clean, non-fluffy dressing be able to cover a cooled burn using a plastic bag, washed in clean water a triangular bandage a non-adherent dressing and a loose bandage appropriate improvised equipment Additional Treatment understand that anything tight around a limb near a burn such as clothing or rings should be removed because of the risk of swelling understand why you should not remove anything that is stuck to the burn Further Treatment understand which burns should go to hospital as quickly as possible, specifically burns to the airway all full thickness burns large burns - superficial more than 5%, partial more than 1% burns to the hands burns to the feet burns to the genitals burns that go all the way around an arm or leg electrical burns chemical burns if there is something stuck to the burn if you are unsure if it is any of the above burns to children especially babies or the elderly understand how to look after a burn that doesn't need to go to hospital, mainly keep it covered until it is dry and at least for a day keep it clean which may mean keeping it covered for longer with a non-adherent dressing until a scab has formed or the skin has healed First Aid Africa 2011 32
7.5 BURNS Overseas The English word burn is not very commonly used in Africa. If you try explaining to someone in English what a burn is it can be quite hard so it s a good idea to have pictures of burns, or examples of things that can give you a burn, to help you Burns are generally very badly treated by lay people in Africa because of the wide variety of local remedies used, such as putting rabbit hair on the burn to help it heal. Invariably, these increase the chance of infection and make the situation worse In many cases, local remedies are part of the traditions of local culture - do not rubbish the ideas but explain why they might not work as well as the treatment you are teaching them, in terms of lack of cooling and increased chance of infection - many local people will have stories of burns that have got worse after local treatment and these can help convince people Burns ALWAYS need to be cooled first - if the burn is not cooled, it will continue to cause damage deeper and deeper in to the skin even if you cannot see it doing so. Some local remedies are actually quite good BUT only if applied AFTER cooling - for example honey is a natural antiseptic and seals the skin preventing infection from entering. However, if you put honey on a burn which isn t cool, it s like adding a glaze to a cooking steak! The best thing to cool a burn is clean, cold, running water clean to reduce the chance of infection cold because you want to cool the burn running because running water takes heat with it as it goes and stays cool where as standing water heats up if you put a burn into it You are almost guaranteed to be asked these questions: What if I don t have water? What if I don t have clean water? What if I don t have much water? What if I don t have running water? combinations of the above! The priority initially is always to cool the burn If you do not have water, any cool clean liquid will do (except drinks with a high alcohol content such as Konyagi as it really hurts - beer is probably ok) If you only have unclean liquid, cover the burn very loosely with something clean and non-adherent/fluffy - preferably plastic - and pour water over the top. The cooling process will take longer If you don't have very much liquid or liquid is not running, place a big bowl underneath the area you are cooling to collect the liquid and then use a cup or a small bowl to scoop up the liquid and pour it back over the burn Burns need to be covered completely to prevent infection: if the burn is being seen at hospital, ideally it should be covered with something plastic and sterile but if you don t have that, it can be covered with anything that is clean and non-fluffy/adherent if the burn is not severe and does not require hospital - it should still be covered with something clean and non-fluffy and the dressing should be changed regularly (approx every 24 hours) until the skin has healed or a scab has formed Anything that you put on a burn should be loose because of the risk of swelling - First Aid Africa 2011 33